Statutory Accident Benefits Schedule matters (SABS)

The applicant sought statutory accident benefits following a motor vehicle accident.

The insurer denied treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered from chronic pain caused by the accident, removing her from the MIG.

The Tribunal ordered the insurer to pay for an orthopaedic assessment and a physiotherapy and chiropractic treatment plan, finding them reasonable and necessary.

Interest was awarded on overdue payments, but the applicant's request for a special award under s. 10 of O. Reg. 664 was denied as the insurer's conduct was not excessively imprudent or stubborn.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she did not sustain a catastrophic impairment and was not entitled to attendant care benefits.

The applicant argued the Tribunal erred by applying the 'but-for' test instead of the 'material contribution' test, misinterpreting the Schedule, failing to find an exacerbation of her pre-existing conditions, and not applying an adverse inference for the respondent's alleged spoliation of expert raw data.

The Tribunal dismissed the request, finding that the applicant was attempting to advance new arguments not raised at the initial hearing and re-litigate findings of fact and weight of evidence.

The Tribunal confirmed no errors of law or fact were made that would have changed the outcome.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the injuries fell within the Minor Injury Guideline.

The matter proceeded to a written hearing before the Licence Appeal Tribunal.

The applicant failed to file any written submissions or evidence, despite receiving notice of the hearing and follow-up correspondence.

Consequently, the Tribunal found the applicant failed to meet their evidentiary burden to demonstrate removal from the Minor Injury Guideline or entitlement to the disputed treatment plans, award, and interest.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a TMJ assessment and a treatment plan for chiropractic, physiotherapy, and acupuncture services.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the TMJ assessment was reasonable and necessary, noting inconsistencies in his self-reporting and preferring the respondent's dental assessor over the applicant's chronic pain specialist.

The Tribunal also found insufficient evidence to support the need for the proposed chiropractic, physiotherapy, and acupuncture services.

The application was dismissed, and no interest was payable.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident, claiming entitlement to attendant care benefits, incurred attendant care expenses, various medical and rehabilitation benefits, and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant failed to meet her evidentiary burden, largely due to significant discrepancies between her written submissions and her hearing brief, which omitted crucial evidence.

The applicant failed to prove that the proposed attendant care and medical benefits were reasonable and necessary, or that the claimed expenses were incurred.

The applicant sought statutory accident benefits following a motor vehicle accident.

The insurer denied several treatment plans, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the claims for an OT neurocognitive assessment, physiotherapy, and a chronic pain assessment were statute-barred, as the applicant failed to file the application within the two-year limitation period following clear and unequivocal denials by the insurer.

The Tribunal also dismissed the claim for psychological services, preferring the insurer's section 44 assessment which concluded the applicant did not suffer from an accident-related psychological impairment at the time the plan was submitted.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied a chiropractic treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnosed whiplash and strains were minor injuries under the Schedule.

The applicant failed to prove that pre-existing conditions prevented maximal medical recovery within the MIG, and subsequent imaging occurred after a second motor vehicle accident.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

The applicant sought entitlement to statutory accident benefits for psychological services and a chronic pain assessment following a motor vehicle accident.

The applicant argued the respondent failed to comply with the notice requirements under s. 38(8) of the Schedule when denying the treatment plans.

The Tribunal found the respondent's denial letters and notices of examination contained sufficient medical reasons and complied with the Schedule.

As the applicant made no submissions on the substantive reasonableness and necessity of the treatment plans, the claims were dismissed, along with claims for interest and an award.

The applicant sought $25,000 for a dental treatment plan following a motor vehicle accident.

The respondent insurer denied the claim, arguing the dental issues were caused by pre-existing periodontal disease rather than the accident.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of the rapid deterioration of the applicant's dental health, relying on the opinion of the applicant's dental surgeon.

The Tribunal concluded the proposed treatment was reasonable and necessary, ordering the respondent to pay for the treatment plan plus interest.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG, claiming he sustained a concussion.

The Tribunal found that the applicant's evidence, primarily from chiropractors, did not establish a concussion diagnosis.

Relying on the clinical notes of the applicant's family physician and an insurer's examination report, the Tribunal concluded the applicant sustained only minor injuries.

As the applicant was subject to the MIG limit, the disputed treatment plans and assessments were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physiotherapy, a chronic pain assessment, and a psychological assessment outside the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found that the applicant's physical injuries were mechanical and myofascial in nature, and his psychological symptoms were minimal and below average.

The Tribunal also found no compelling medical evidence that the applicant's pre-existing seizure disorder precluded recovery within the MIG.

The application was dismissed, and the applicant was held to the MIG limits.

The applicant sought statutory accident benefits following a motor vehicle accident.

The Licence Appeal Tribunal denied the applicant's claims for physiotherapy, chiropractic, and psychotherapy treatment plans, as well as medication expenses, finding insufficient medical evidence and a failure to attend a required insurer examination.

However, the Tribunal found that the insurer unreasonably delayed approving a psychological assessment after the applicant was removed from the Minor Injury Guideline.

The Tribunal ordered the insurer to pay a $440 special award and interest on the delayed assessment.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing condition, chronic pain, and a psychological impairment.

The Tribunal found the applicant's psychological evidence unpersuasive due to provisional diagnoses and inconsistencies in reporting.

The Tribunal also found insufficient evidence that pre-existing conditions precluded recovery or that the applicant suffered from chronic pain with functional impairment.

The application was dismissed, and the injuries were deemed subject to the MIG limit.

The applicant sought various statutory accident benefits following a motor vehicle accident, including increased attendant care benefits, multiple treatment plans, and expenses for eyeglasses.

The Licence Appeal Tribunal dismissed all claims.

The Tribunal found the applicant failed to provide evidence of incurred past attendant care expenses and preferred the respondent's occupational therapy assessment for ongoing care, concluding that 24/7 care was not justified.

The claims for treatment plans and assessments were dismissed due to a complete lack of supporting evidence, and the claims for eyeglasses were denied because the expenses had not been incurred.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and various treatment plans.

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to establish that he suffered a concussion, a pre-existing condition, a psychological injury, or chronic pain that would warrant removal from the MIG.

The Tribunal also found that the applicant did not meet the test for non-earner benefits, as he failed to demonstrate a complete inability to carry on a normal life.

The application was dismissed.

The applicant sought $1,710 for chiropractic services following a 2019 motor vehicle accident.

The respondent denied the treatment plan based on a section 44 physiatry assessment.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, as the supporting medical evidence predated the treatment plan by over a year and the contemporaneous section 44 assessment concluded the applicant had reached maximum medical improvement.

The application was dismissed, and claims for interest and an award were denied.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued he suffered from chronic pain warranting removal from the MIG.

The Tribunal found the medical evidence did not support a diagnosis of chronic pain with functional impairment, noting the applicant failed to meet the criteria under the AMA Guides.

As the injuries were predominantly minor and the MIG limits were exhausted, the application for benefits and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his psychological injuries warranted removal from the Minor Injury Guideline (MIG).

The adjudicator reviewed competing psychological assessments.

The applicant's expert diagnosed an adjustment disorder, while the respondent's expert found no significant symptomology and suspected malingering.

The adjudicator preferred the respondent's expert evidence, noting it aligned with the applicant's own reports to other assessors that he was not experiencing emotional difficulties.

The adjudicator concluded the applicant failed to prove a psychological condition warranting removal from the MIG.

Consequently, the disputed treatment plans were not payable and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The matter proceeded to a written hearing, but the applicant failed to file any written submissions or evidence.

As the applicant bore the onus of demonstrating removal from the Minor Injury Guideline and entitlement to the claimed benefits, the Tribunal found she had not met her evidentiary burden.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

After the applicant's representative removed himself from the record, the applicant failed to file any written submissions or evidence for the scheduled written hearing.

The Licence Appeal Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The Tribunal found that the applicant failed to meet the burden of proving entitlement to the claimed benefits and dismissed the application.